本病例為一位六十五歲類肉瘤腎細胞癌患者以持續性嗜中性球增多症為初始臨床表現。病人在例行團體檢時發現白血球增多症。於往後六個月中白血球增多症持續存在。白血球增多達36.6×l0^9/L,且屬中性球增生。骨髓檢查發現骨髓增生。骨髓細胞遺傳學檢查為46,XY。LAP為226 U/L,網狀細胞指數為0.5%, ferritin為325 ng/ml。病人並無發燒、淋巴腺病或肝脾腫大現象。由於發生嚴重的腰部疼痛,電腦斷層檢查發現病人有腎臓腫瘤;之後患者接受單側腎臟、部分大腸和脾臟切除。病理學檢查為類肉瘤腎細胞癌,以UICC TNM分期為T4N0M1。手術後白血球數降至7.l×l0^9/L。此種癌症診斷前之附屬腫瘤症候群並不多見,值得臨床醫師注意。
We report a case of sarcomatoid renal cell carcinoma in a 65-year-old man presenting initially with persistent neutrophilia. The patient was incidentally found to have leukocytosis at a routine physical check-up. During the ensuing six months, a white cell count as high as 36.6×10^9/L with neutrophilia was noted. Bone marrow examination showed myeloid hyperplasia. The cytogenetic result was 46,XY. Pertinent laboratory data showed: LAP score of 226 U/L, mild normocytic anemia with reticulocyte index of 0.5%, and ferritin of 325 ng/ml. There was no febrile episode, lymphadenopathy, heaptosplenomegaly. After an episode of severe left flank pain, he was found to have renal tumor. The patient ultimately underwent radical nephrectomy, segmental resection of the splenic flexure colon and splenectomy. The pathology was diagnosed as sarcomatoid renal cell carcinoma, staged at T4N0M1 by UICC TNM criteria. The WBC count dropped dramatically to 7.1×10^9/L after surgery. This kind of paraneoplastic syndrome prior to the detection of cancer is uncommon and all clinicians should be aware of it.
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